Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 52026 | WI |
NPI | 1194930958 |
---|---|
Provider Name | Dr. Edward J Hayes |
First Address | Green Bay, WI 54311-6519 |
Second Address | Green Bay, WI 54311-6519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35354700 | (05) | WI |
52026 | WI LICENSE (01) | WI |